Enhanced Community Care

The HSE’s Enhanced Community Care (ECC) programme is increasing community healthcare services and reducing the pressure on hospital services.

This means more services are now closer to where people live, especially:

  • older people
  • people with chronic disease

 The programme helps health and social care services to:

  • manage care at a local level
  • prevent avoidable referrals and admissions to acute hospitals, where safe and appropriate to do so
  • support the transition from hospitals to the community

The ECC programme is a €240 million investment in community health services. It is part of the Sláintecare programme.

Community specialist teams

Community specialist teams are located across all HSE health regions. Each team serves a population of about 150,000 people.

Their aim is to:

  • improve people’s quality of life
  • support people to live well in their own homes and communities

Speak to your GP or medical team to find out more.

Community specialist teams for older people

The Integrated Care Programme for Older People (ICPOP) community specialist teams provide services for older people who:

  • have complex needs
  • need specialist multidisciplinary intervention to help maintain their independence and live well at home

The team provides a comprehensive geriatric assessment, where members of the team work together to assess and respond to an older person’s needs.

The team includes nurses, a physiotherapist, an occupational therapist, a speech and language therapist, a social worker and dietician, under the governance of a consultant geriatrician. This provides a “one-stop-shop” for older people with complex needs.

The assessment is a full evaluation of an older person’s:

  • medical conditions
  • functional capacity
  • social circumstances

It results in a coordinated plan and delivery of care, which leads to better health outcomes. The team provides access to community-based treatment for eligible older people for a period of up to 6 weeks.

An older person can get a referral from their GP or consultant geriatrician. Speak to your GP or medical team to find out more.

Community specialist teams for chronic disease

Community specialist teams for chronic disease help people to understand and manage their illness. This service is for people age 16 and over, with 1 or more chronic diseases.

The team provides services such as:

  • early detection and intervention
  • diagnostics
  • GP services
  • specialist supports in the community
  • COPD outreach

Speak to your GP or medical team to find out more.

Structured chronic disease treatment programme

This programme is for people who have 1 or more of the following chronic diseases:

  • type 2 diabetes
  • asthma
  • chronic obstructive pulmonary disease (COPD)
  • cardiovascular disease, including heart failure, heart attack (angina), stroke and irregular heartbeat (atrial fibrillation)

The programme helps you and your doctor to work together to:

  • manage your condition better
  • avoid hospital stays

The programme focuses on:

  • keeping an eye on your condition
  • catching and treating problems early
  • supporting you to manage your condition

You must be age 18 or older and have a medical cardGP visit card or Health Amendment Act card to join the programme. Speak to your doctor or practice nurse to find out more.

Chronic disease treatment programme

Annual chronic disease management prevention programme

This programme is for people who:

If your GP thinks you're at risk, they will ask if you want to join the programme.

The programme is free and helps you and your doctor to work together to lower your chances of getting heart disease or diabetes.

Annual chronic disease management prevention programme

Community healthcare networks

Community healthcare networks (CHNs) deliver primary healthcare services across Ireland. Each network serves a population of about 50,000 people.

CHNs improve the experience of using these services by:

  • supporting people to live more independently in the community
  • coordinating and integrating services to meet health needs
  • supporting collaborative working to provide person-centred care
  • ensuring access to services nationwide at the right time

The ECC programme will also develop a volunteer model with Alone - alone.ie. This will help to coordinate community and voluntary supports in each CHN.

Community healthcare networks

Community intervention teams

Community intervention teams (CITs) provide care to patients with a sudden illness who may need enhanced services or acute intervention for a short period of time.

The team can:

  • facilitate early discharge from hospital
  • help people avoid hospital
  • support people to live well with a chronic disease at home

Speak to your GP, hospitals and community services for a referral or to find out more.

Progress under the ECC programme

The ECC programme has delivered:

  • 96 of 96 community healthcare networks
  • 24 of 30 community specialist teams for older people
  • 24 of 30 community specialist teams for chronic disease
  • 21 community intervention teams
  • 2,900 additional staff
  • 310,374 Radiology tests or scans were reported as completed between January 2023 and November 2023. It is expected the total scans conducted will surpass the 253,172 conducted in 2022.
  • 91% of patients with chronic disease are, routinely, fully managed in primary care via the Chronic Disease Management in General Practice programme.

The Irish College of General Practitioners review indicates that GP access to diagnostics:

  • reduces the number of patients requiring referral to emergency departments or acute medical units by 89%
  • reduces the number of patients requiring referral to public outpatients by 53%
  • frees diagnostic capacity in public radiology departments by 25%

Stories

Read stories about how we are bringing care closer to people’s homes:

  1. Linda praises her mum’s dementia care
  2. New Portiuncula service enhances care for older persons
  3. Alan praises support following stroke
  4. Marie expresses “delight” with diabetes course
  5. Parkinson’s group benefits participants and carers
  6. Kerry service keeps older people safely in own homes
  7. New Centre supporting older people in Waterford
  8. Sally happy to be well at home via Cork hub
  9. Specialist local services mean patients avoid hospital visits
  10. Celine delighted at local service to manage asthma
  11. “Fantastic service” helps Paddy recover at home